INR drop with Warfarin manufacturer change

[Natanni]

We order Nathan's Warfarin in 90 day supply from Innoviant, and they have switched Warfarin drug companies twice on us, both times with a noticed INR change. Nathan dropped from a solid 2.8 to a 2 week consistant 2.1 with change from BARR to Zydus Phar. We did wait week to make sure the INR did really drop, and this week we are upping his dosage. This is frustrating to have our insurance changing brands like this, and I know it is not suppose to cause a change, but this 2nd time his INR changed with brands. I would rather stick with a local Walgreens and get the same med all time time as was the case before we had to go mail order. Anyone else out there note a change? Can we demand the same drug maker?

 

[Ross]

I've used every brand, generic and name brand and have never had any change in INR.

 

[Natanni]

This happened the exact same way last time, he changes companies, we test....and he is lower....we wait a week, and he is still the exact same, so he adjusts and he is fine, until they send the next untried brand. How many are manufacturers of Warfarin are there out there?

 

[Ross]

In the U.S. Barr, Taro, and Jantoven then of course brand name Coumadin. I don't know of any others. Googling warfarin sodium tablets, yields Zydus and one other pharmaceutical company. These I have not heard of, so I would imagine there are more.

 

[Natanni]

Okay, I am glad you had not heard of Zydus yet either Ross. I have been a nurse since 1990 and had not yet heard of Zydus.

 

[ALCapshaw2]

I had NO problem switching from Coumadin to TARO (made in Israel) to BARR (made in USA). All 3 are well known GOOD suppliers. I've never heard of the other companies you mentioned.

Have you complained to the mail order provider,
or the new supplier?

'AL Capshaw'

 

[Natanni]

Innoviant, "the company" really made a mess of things; And this is just the coumadin. They screwed up his cholesterol meds and Toprol as well!

We had a new RX for Warfarin 2.5 mg, and I ordered 90 day of the 2.5mg and re-ordred the usual 5.0mg (5mg 7 days per week with 2.5 one day per week)
. To Innoviant, this made no sense; So they discontinued his 5.0 mg without asking, because why in the world would we want 2.5mg AND 5.0 mg....clearly I must have made a mistake So when I told them I need BOTH, they sent us this new brand....yes....I have been complaining but not about changing manufacturers...that will come next tomorrow. It is going to be a big pain, but I think we need to have Nate's Warfarin filled in 30 day supply locally (they will only do 30 days non mail order). Nathan noticed the first change from Barr to Taro (I did the same that I did today crying on your guys's shoulder, I looked back into archieves, hehehe). Thanks for the input guys....

 

[Bina]

I don't know about generic warfarin.....but my father has a RX for angina meds. He took them for months without problem, then the drugist changed it for a generic version and my father had immediate chest pain....he switched back to the name brand and was fine.

 

[Kathleen]

I use both the mail order and the local pharmacy. If I would use the mail it is 90 days local 30 which to me seems wrong that they can make those types of rules. My local pharmacist called the insurance company and said he wanted special permission to dispense 90 days for me due to the fact that I take so many heart meds that I would be filling a script weekly and the insuranc ecompany agreed. I now can do either at 90 days and do the cost analysis of each med. I have BCBS Federal Employees. Perhaps you can get the ok to do the same. I don't trust the mail making sure my warafin order is placed correctly and send on time .
Kathleen

 

[Karlynn]

I did have a problem with a generic version about 3 months ago. I know from Al L. that there shouldn't be any difference, but I experienced an increase in my INR (sometimes by 2.0) when taking a 5mg generic. I don't recall the company and that makes me mad, wish I could tell you. I narrowed the rise in INR down to the generic by changing back and forth between the generic and Coumadin. I have had other generics with warfarin and didn't have a problem - I did with this particular one.

My cardio refuses to prescribe generic, but occasionally she'll forget to check the "no substitutions" box and I'll get the generic. Never had any issues up until those 5 mg tabs.

 

[ALCapshaw2]

Hmmm.....

This reminds me of a special report by John Stossel(sp?) on 20/20 about COUNTERFEIT Drugs (from overseas I think). I don't remember anything specific about Coumadin or Warfarin. The investigation started with some Cancer Drugs after a patient died as I recall. Even the BOXES were identical 'look-alikes'.

Wonder if the Pharmacy would be interested in having the drugs checked for potency / authenticity???

'AL Capshaw'

 

[Lisa in Katy]

I had an issue some time ago (1998-99) with a generic version where my INR bounced around more than usual. Since the generics just came out in 1997, I decided that it was just one that slipped through the system. I don't know who the manufacturer was and can't find one that looks like it online. The pills were shaped like bowties (or Milkbones) with a score mark in the center where the knot would be. I've been taking the Barr version for some time now and am probably one of the most stable people in the history of Warfarin!

 

[Guest]

When I wrote about them being equal, there were only a few generics out there. Zydus was not in any study that I know about. There is a possibility that they have a problem. I don't know that there is a problem, all I'm saying is that they haven't been studied.